정신분열병 환자에서 올란자핀과 연관된 체중 증가에 대한 니자티딘의 효과 : 예비 연구

배치운(Chi-Un Pae),정유경(Yoo-Kyung Jung),이창욱(Chang-Uk Lee),이수정(Soo-Jung Lee),이철(Chul Lee),백인호(In-Ho Paik) 대한생물치료정신의학회 2003 생물치료정신의학 Vol.9 No.1

본 연구는 올란자핀을 투여 후 체중 증가가 관찰된 정신분열병 환자들을 대상으로 nizatidine의 효과를 조사하고자 시도되었다. 올란자핀을 처음 투여 받은 환자들 중 체중 증가가 발생된 10명을 대상으로 하였다. 모든 환자에게 nizatidine을 300㎎/day로 투여하였으며 임상 증상에 미치는 영향을 배제하기 위하여 PANSS와 BPRS를 기저 시점과 nizatidine 투여 후 4주 및 8주 시점에 측정하여 임상 증상의 변화를 평가하였다. 연구 시작 후 4주 및 8주 시점에서 체중 변화는 각각 1.1㎏(1.5%)와 2.5㎏(3.5%)이었으며 BMI의 경우 4주와 8주 시점에서 각각 0.4(1.6%)와 0.9(3.7%)로 연구 기간동안 모두 유의한 감소를 보였다. 올란자핀을 복용하여 체중 증가가 관찰되었던 10명의 정신분열병 환자를 대상으로 하여 8주간 nizatidine을 투여한 결과, 연구 방법상의 제한점이 있으나 nizatidine은 올란자핀 관련체중 증가의 치료에 효과적인 약물로 생각된다. Objectives : This pilot study was conducted to evaluate the effect of nizatidine on olanzapine-associated weight gain(OAWG) in schizophrenic patients in Korea. Methods : Ten subjects with OAWG from outpatients clinic who were diagnosed with schizophrenia and schizophreniform disorder in accordance with DSM-Ⅳ criteria. Positive and Negative Syndrome Scale(PANSS) and Brief Psychiatric Rating Scale(BPRS) were measured at baseline, week 4 and week 8 as were weight and Body Mass index(BMI). A flexible dose of olanzapine plus fixed 150㎎(b.i.d) dose of nizatidine was administered to all patients. Weight and BMI(㎏/m²) were recorded at each visit. Results : A combination of nizatidine resulted in significant reversal of OAWG without worsening the psychopathology. In line with studies of Western populations, an add-on therapy of nizatidine could be an effective option for the control of weight gain in olanzapine-treated patients in Korea. Conclusion : Our findings call for further evaluation of the effect of this drug on schizophrenics, with randomized placebo-controlled studies, in Asian populations.

거미낭으로 일과성 정신병 유발이 의심되고 리스페리돈 치료에 효과적이었던 증례

박원명,배치운,전태연,김광수,유태열,Bahk, Won-Myong,Pae, Chi-Un,Jun, Taeyoun,Kim, Kwang-Soo,Lew, Tae-Yul 대한생물정신의학회 2001 생물정신의학 Vol.8 No.1

There had been few reports of arachnoid cyst accompanying psychiatric disturbance and no report treated with low-dose risperidone administration. We report a patient, developed first-transient psychotic episode considered to be provoked by an arachnoid cyst, responsive to risperidone, which was found in the middle cranial fossa as follows. A 57-year-old man was admitted by suddenly developed headache, auditory hallucination, delusion of persecution and, an arachnoid cyst in the anteromedial aspect of middle cranial fossa was found on MRI after admission. The psychotic episode was first to him and he was also negative to other clinical evaluation including endocrine abnormality, his psychotic symtom was suspected to be induced by arachnoid cyst and was well controlled to low-dose risperidone administration. He left hospital free from psychotic symptoms on 14 hospital days.

흡연갈망의 신경해부학적 특이성:기능자기공명영상연구

임현국,배치운,이창욱,Lim, Hyun-Kook,Pae, Chi-Un,Lee, Chang-Uk 대한생물정신의학회 2005 생물정신의학 Vol.12 No.1

Object:Nicotine dependence is the most common substance abuse disorder. One of the characteristics of nicotine dependence is craving. Regional activation of the brain induced by craving for nicotine was evaluated by using functional magnetic resonance imaging to investigate neuroanatomical site of smoking craving. Method:A smoker who satisfied DSM-IV criteria for nicotine dependence and a non smoker was studied. MRI data were acquired on a 1.5T Magnetom Vision Plus with a head volume coil. Two sets of visual stimuli were presented to subjects in a random manner. One was the film scenes of inducing smoking craving and the other was neutral stimuli not related to smoking. There were two fMRI sessions before and after smoking or sham smoking. Data were analyzed using SPM99. Results:fMRI showed significant activated area in anterior cingulate and medial frontal lobes in the smoker during smoking craving. Right dorsolateral prefrontal cortex and parietal lobes were activated in the control during visual stimulation before smoking. After smoking, there was no brain activation during visual stimulation in both of smoker and non smoker. Conclusion:Metabolic activity of the anterior cingulate and medial frontal lobes increased during craving for smoking. This result suggests that fMRI may be a valuable tool in the identification of neurobiological process of craving.

주요 우울증에서 Interleukin-10 유전자의 제한효소 절편길이 다형성

전태연,배치운,이정태,박원명,김광수,Jun, Taeyoun,Pae, Chi-Un,Lee, Chung Tai,Bahk, Won-Myong,Kim, Kwang-Soo 대한생물정신의학회 2000 생물정신의학 Vol.7 No.2

Objective : Major depression is known to have immunologic dysfunctions, the recent studies revealed that cytokines including IL-6 and IL-$1{\beta}$ were increased in patients with major depression. Since molecular genetic methods have been progressed, this study was to investigate the relationship between major depression and immunologic aspects by analyzing polymorphism of IL-10 gene. Method : 92 patients with major depression were included and data of 146 normal controls obtained from the Catholic Hemopoietic Stem Cell Information Bank of Korea were used in this study. DNA was extracted from whole blood, thereafter amplified by polymerase chain reaction, and digested by Mae III After that procedure, we obtained and assessed RFLP of two alleles, IL-10T and IL-10C. All data were analyzed by ${\chi}^2$ test. Results : 1) There were no significant difference in genotype frequencies of $IL-10^*T/T$, $IL-10^*T/C$, and $IL-10^*C/C$ between major depression patients group and control group. 2) There were no significant difference in allelic frequencies of $IL-10^*T$ and $IL-10^*C$ between major depression patients group and control group. Conclusion : We did not verified the differences in frequencies of $IL-10^*T/^*IL-10^*C$ gene between the major depression patients group and control group, respectively. But the results of this study do not declare that the IL-10 gene has no association with major depression. We do suggest that further systematic studies including various clinical variables should be conducted.

정신분열병 환자의 작동기억 이상에 대한 기능적 자기공명영상 연구

박여진,김태석,노사봉,배치운,김정진,이수정,이철,백인호,이창욱,Park, Yuh-Jin,Kim, Tae-Suk,Roh, Sa-Bong,Pae, Chi-Un,Kim, Jung-Jin,Lee, Soo-Jung,Lee, Chul,Paik, In-Ho,Lee, Chang-Uk 대한생물정신의학회 2005 생물정신의학 Vol.12 No.1

Objective:Impaired processing of working memory is one of the cognitive deficits seen in patients with schizophrenia. This aimed at corroborating the differences in the brain activities involved in the process of working memory between patients with schizophrenia and the control subjects. Method:Fourteen patients with schizophrenia and 12 healthy volunteers were recruited in this study. Functional magnetic resonance imaging(fMRI) was used to assess cortical activities during the performance of a 2-back visual working memory paradigm using the Korean alphabet as mnemonic content. Results:Group analysis revealed that left lateral prefrontal cortex and right parietal lobule showed decreased cortical activities in the patient group. On the other hand, an increased activation in left superior and middle frontal gyrus, left middle temporal gyrus, right cuneus, both occipital lobes, right fusiform gyrus and right cingulate gyrus. The activation in left anterior lobe and both declive of cerebellum was also increased. Conclusions:This study showed a decreased activation in left lateral prefrontal and right parietal neural networks from the patient group and confirmed the earlier findings on the impaired working memory of patients with schizophrenia using fMRI investigation. The regions implicated in our study suggest an abnormal functioning of the fronto-parietal cortical areas that are critical to the information processing stream, which might be correspondent to common pathophysiology rather than a common etiology in schizophrenia.

인터넷 시대와 정신과

박원명(Won-Myong Bahk),배치운(Chi-Un Pae) 대한사회정신의학회 2001 사회정신의학 Vol.6 No.1

1999년도의 인터넷 사용자는 1억 6천만 명, 연간 e-mail 사용 회선은 2조 7천만번, 건강 관련 websites는 10만개에 달하였으며, 2002년에는 인터넷 사용자가 전세계적으로 3억 명에 달할 것으로 추산될 정도로 computer를 이용한 정보의 공급과 소비는 더욱 늘어날 전망이다. 정신과 영역에서도 인터넷의 보급은 확산 일로에 있지만 정신과 영역에서 장점과 위험성 등 그 잠재성은 정확하게 알려져 있지 않다. 또한, 인터넷은 수많은 환자와 정신과 의사가 무한의 정보를 교류할 수 있는 영역이며 동시에 비밀 유지(confidentiality), 환자와의 소통방법 변화, 임상적 적용과 관련된 적절한 software의 개발 필요성 등 변화에 적절히 대응해야할 요소가 많으므로 본고에서는 Internet communication의 model, 정신과 영역에서 최근 대두되고 있는 인터넷으로 인한 부정적인 영향, 정신과적 적용과 한계, 그리고 미래 등을 문헌과 online 검색을 통하여 소개하려고 한다. In 1999, the internet had 160 million users world wide, the number of websites related to health is 100000, and with 2.7 trillion e-mail messages sent annually. By the year 2002 it is anticipated that there will be 300 million internet users. At present, with increasing the internet services, but there is no accurate information and knowledge of internet application in psychiatry. Additionally, internet is the communicative field of many psychiatrists and patients, and has some problems including confidentiality, change of communication with patients, need of software related to clinical practice, and so on. According to recent trends, in this article authors want to introduce potential risks and adverse events, model of internet communication, the drawbacks and application to psychiatric area, and the future by journal review and online search.

양극성 장애 환자에서 CTLA-4 유전자 다형성

전태연,이경욱,이혁재,배치운,채정호,박원명,김광수,Jun, Tae-Youn,Lee, Kyoung-Uk,Lee, Hyuk-Jae,Pae, Chi-Un,Chae, Jeong-Ho,Bahk, Won-Myong,Kim, Kwang-Soo 대한생물정신의학회 2003 생물정신의학 Vol.10 No.1

Objective : Bipolar disorder is known to have strong genetic background and cellular immune activation. Based on the hypothesis that abnormalities of normal inhibitory control of T cell immunity can contribute to the pathophysiology of bipolar disorder, we investigated the relationship between the first exon at position +49(A/G) polymorphism of cytotoxic T lymphocyte antigen 4(CTLA4) gene and bipolar disorder. Method : Among the Korean patients diagnosed as bipolar disorder according to DSM-IV, 90 patients without serious medical illness, neurologic illness, hormonal disorder, or concomitant mental illness were selected. The normal control group consisted of 149 age-and sex-matched subjects without current or past history of autoimmune diseases or mental disorder. DNA was extracted from whole blood and the exon 1 region of CTLA-4 gene was amplified by polymerase chain reaction. Gene typing was performed using single strand conformation polymorphism. Results : There were no significant differences in genotype frequencies of G/G, G/A, and A/A between the patients with bipolar disorder and the control group(48.9% vs 46.3%, 44.4% vs 39.6%, and 6.7% vs 14.1%, respectively). There were no significant differences in allelic frequencies of G and A between the patients with bipolar disorder and the control group(71.1% vs 66.1%, and 28.9% vs 33.9%, respectively). Conclusion : This study did not show the association of exon 1 polymorphism of CTLA-4 gene with bipolar disorder.

알츠하이머 치매 환자에 동반된 정신병적 증상 치료에 관한 아미설프리드와 리스페리돈의 효과와 안정성에 대한 비교 연구

임현국(Hyun-Kook Lim),김수진(Su-Jin Kim),배치운(Chi-Un Pae),이철(Chul Lee),이창욱(Chang-Uk Lee) 대한노인정신의학회 2007 노인정신의학 Vol.11 No.1

This study compared the effectiveness and tolerability of amisulpride and risperidone in patients with psychosis associated with dementia of the Alzheimer’s type (DAT). This 8-week open label study randomized 72 patients with DAT associated psychosis either to amisulpride (n=36) and risperidone (n=36). The effectiveness of the treatments was assessed with the Korean version of Neuropsychiatry Inventory (K-NPI) psychosis subscale and total K-NPI and the Clinical Global Impression-Severity of Illness (CGI-S) scale. The Simpson-Angus Rating Scale, the Barnes Akathisia Rating Scale and the Abnormal Involuntary Movement Scale were used for the assessment of side effects. The K-NPI psychosis subscale, total K-NPI and CGI-S scores were significantly decreased over time in both treatment groups without any significant group difference and time by the group interaction effect. There were no serious adverse events in both groups. This study showed that either amisulpride or risperidone would be effective and tolerable for treating psychotic symptom associated with DAT. Adequately powered studies with a head-to-head comparison design will be mandatory to draw any definite conclusion.

한국 남성 알코올의존 환자에서의 COMT 유전자 다형성

권용실(Yong-Sil Kweon),이해국(Hae-Kook Lee),이정태(Chung Tai Lee):배치운(Chi-Un Pae) 한국중독정신의학회 2003 중독정신의학 Vol.7 No.1

Catechol-O-Methyltransferase (COMT) is an enzyme which play a crucial role in the metabolism of dopamine. It has been suggested that COMT provide molecular role in development of alcohol dependence because of its genetic polymorphism associated with 3-4 fold variation in enzymatic activity. We carried out an association study to verify the relationship between COMT gene polymorphism and alcohol dependence with violent behavior in Korean population. Ninety seven (97) male alcoholics and 94 male normal controls who did not have history of psychiatric illness were enrolled in this study. After amplifying COMT genes by polymerase chain reaction and assessed genotype and allele by Restriction Frag-ment Length Polymorphism (RFLP). Distribution of COMT genotype and allele frequencies between patients and controls was not significantly different. However, the differences between violent group and nonviolent group were significant in frequencies of COMT genotype (χ 2 =7.977, df=2, p=0.019) and allele (χ 2 = 6.832, df=1, p=0.012). Additionally, the differences between nonviolent groups and controls were significant in frequencies of COMT allele (χ 2 =4.481, df=1, p=0.040). This result suggest that COMT gene polymorphism is not associated with the development of alcohol dependence, but may affect a susceptibility to clinical heterogeneity of alcohol dependence, at least in the Korean population.

노인 입원 환자에 대한 일 대학 병원의 리스페리돈과 올란자핀의 처방 경향 : 자연적 연구

임현국(Hyun Kook Lim),최은형(Eun Hyung Choi),이영란(Young Ran Lee),오근(Keun Oh),배치운(Chi Un Pae),이철(Chul Lee),백인호(In Ho Paik),이창욱(Chang Uk Lee) 대한노인정신의학회 2007 노인정신의학 Vol.11 No.1

Several studies have reported that either risperidone or olanzapine is effective and tolerable in the elderly patients with psychotic symptoms. However, there is a lack of clinical data of risperidone and olanzapine prescription for elderly patients in the Aisan population. We reviewed retrospectively the medical records of risperidone (n=112) and olanzapine (n=96) treated patients older than age 60 who were admitted to a university-affiliated hospital between October 2005 and August 2006. The mean daily dose of risperidone was 3.4±1.5 mg and olanzapine, 8.8±5.6 mg, respectively. The response rate on the CGI (much and very much improved) appeared to be 67.4% in the risperidone group and 70.8% in the olanzapine group, respectively. Adverse events were reported in 48.2% in the risperidone group and 46.9% in the olanzapine group, without serious adverse events, respectively. This study showed that either risperidone or olanzapine would be effective and tolerable in elderly patients with psychotic symptoms and that provides similar results to those reported from western countries.